Health system building block | Sub-category | Priority actions |
---|---|---|
Leadership and governance | Policy and guidelines | • Develop, update and disseminate the national policy on prevention and management of preterm labour; this should include policy on ACS use • Advocate for newborn health to be made as a priority • Develop national clinical protocols and guidelines on management of preterm labour |
Health financing | Funding/budget allocation | • Increase funding / budget allocation for newborn care • Advocate and lobby for more funding from partners in newborn health |
Cost of antenatal corticosteroids | • Assess financial implications and develop financial policy for supplies and services to deliver this intervention to beneficiaries • Include antenatal corticosteroids as part of the free MNCH policy • Scale up obstetric kits by including relevant newborn drugs such as antenatal corticosteroids | |
Health workforce | Policy restriction for prescription and administration | • Authorise all skilled births attendants to prescribe and administer ACS |
Job descriptions/job aids | • Develop and disseminate job aids | |
Shortage of qualified staff | • Recruit and train competent health providers • Develop an electronic database to track training activities and identify needs • Ensure staffing norms are in line with WHO recommendations | |
Competency and training | • Strengthen competency based pre-service and in-service training, and on job training to capture use of ACS by health providers for fetal lung maturation • Include ACS training in skilled birth attendant evaluation | |
Health service delivery | Service availability | • Develop and disseminate national guidelines in health facilities • Establish follow-up visits to monitor availability and use of ACS in all health facilities |
Quality of care | • Establish a supportive supervision and mentoring mechanism with a reward system; • Regular integrated monitoring visits to ensure compliance to protocols; • Integrate ACS use in clinical audits and reviews; | |
Referral systems | • Involve all stakeholders to improve infrastructure for timely referral (road network) • Build district-level capacity to monitor appropriate use of ambulances and ensure adequate maintenance | |
Essential medical products and technologies | Procurement policy | • Include ACS in national essential medicines list with appropriate indication (fetal lung maturation) |
Drug availability | • Develop and disseminate policy in health facilities to enhance procurement | |
Logistics management information systems (LMIS) | • Estimate needs based on number/estimate of preterm birth load at health facilities • Build staff capacity for logistics management | |
Health information system | Data collection and reporting | • Define indicator(s) for tracking ACS use and incorporate into national system • Strengthen monitoring mechanisms such as regular monitoring and evaluation visits, documentation through use of program data. • Conduct regular review meetings on data management at all levels |
Community ownership and participation | Knowledge / awareness | • Conduct integrated community maternal and newborn education and campaigns in local languages • Improve community awareness on newborn health by adding newborn information to maternal awareness documents, campaigns, media, etc. |
Community participation / engagement | • Strengthen community leaders and male involvement through innovative approaches; • Strengthen functioning of existing community units with nationwide community awareness initiatives on newborn health • Health facilities to come up with innovative ways of involving men e.g. set aside time for couples during antenatal visits and time for adolescents | |
Demand for preterm birth care | • Scale up tribal empowerment project to address socio-cultural barriers to newborn care • Utilise community radio and mobile applications |